key: cord-304743-0bsdahh6
authors: Kortepeter, Mark G; Dierberg, Kerry; Shenoy, Erica S; Cieslak, Theodore J; Bhadelia, Nahid; Davey, Richard T; Evans, Jared D; Frank, Maria G; Grein, Jonathan; Kraft, Colleen S; Kratochvil, Chris J; Martins, Karen; McLellan, Susan; Measer, Greg; Mehta, Aneesh K; Raabe, Vanessa; Risi, George; Sauer, Lauren; Uyeki, Timothy
title: Marburg Virus Disease: a Summary for Clinicians
date: 2020-08-03
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.07.042
sha: 
doc_id: 304743
cord_uid: 0bsdahh6

Abstract Objectives This article is a summary of countermeasures for Marburg virus disease focusing on pathogenesis, clinical features, and diagnostics, with an emphasis on therapies and vaccines that have demonstrated potential for use in an emergency situation, through their evaluation in nonhuman primates (NHPs) and/or in humans. Methods A standardized literature review was conducted on vaccines and treatments for each pathogen, with a focus on human and nonhuman primate data published in the last five years. More detail on the methods used are summarized in a companion methods paper. Results We identified six treatments and four vaccine platforms that have demonstrated potential benefit for treating or preventing infection in humans, through their efficacy in NHPs. Conclusion We provide succinct summaries of Marburg countermeasures to give the busy clinician a head start in reviewing the literature if faced with a patient with Marburg virus disease. We also provide links to other authoritative sources of information.

This is the first in a planned series on the management of highly hazardous communicable pathogens that may warrant specialized infection control measures and lack Frankfurt, Germany and Belgrade, Yugoslavia, as well as a subsequent outbreak among three travelers cared for in South Africa. (Martini, 1971; Gear et al, 1975) Following the incubation period, patients usually become ill abruptly, with non-specific symptoms such as fever, chills, headache, odynophagia, myalgia, vomiting, and diarrhea. Early cases may be missed, owing to similarities with more common infections, such as malaria, typhoid, or rickettsial illness.

Rash is a common feature early in MVD, and is described as non-pruritic, erythematous, and maculopapular. It may begin focally, then become diffuse and confluent. As noted during the original outbreak, "It began between the fifth and seventh day at the buttocks, trunk, and outside J o u r n a l P r e -p r o o f of both upper arms as a distinctly marked, pin-sized red papula around the hair roots," which lasted up to 24 hours, then developed into a maculo-papular rash, which later coalesced. (Martini, 1971 ) Conjunctival injection may also occur early.

During MVD, wide swings of body temperature have been noted, encompassing hyperand hypo-pyrexia. In the original outbreak, tachycardia corresponding to temperature elevation was only seen in fatal cases. Lab abnormalities include leukopenia and lymphopenia, hypokalemia, normal to elevated levels of amylase, thrombocytopenia, and elevated liver enzymes. As illness progresses, elevations in prothrombin time and partial thromboplastin time, as well as clinical bleeding, may occur. Patients may develop multiple foci of mucosal hemorrhage, typically in the conjunctivae, along with easy bruising or persistent bleeding from venipuncture sites. Renal function may be normal initially, although by the end of the first week of illness, renal function is often impaired and dialysis may be required. Severe cases progress from prostration and obtundation to hypotension, shock, and multi-organ failure. In the West African outbreak of EVD, significant gastrointestinal disease was described, with vomiting and diarrhea leading to volume loss, acid base disturbances, and electrolyte imbalances. 

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